Argentum continues to raise concerns with newly introduced legislation that could strain communities, limit innovation, and ultimately reduce access to care for seniors. The Assisted Living Affordability, Choice, Community, Empowerment, Savings and Support (ACCESS) Act (S. 4479 and H.R. 8662), would make assisted living a covered Medicaid benefit for seniors who meet nursing facility level-of-care criteria, but also invite new federal regulation layered on top of existing state regulatory frameworks.
We encourage all senior living stakeholders to join us in sending a letter to your federal lawmakers to share your concerns with this bill. While Argentum has met with the bill sponsors and other lawmakers to express our concerns, often the most powerful message comes directly from constituents who can relay how these impacts would be felt on seniors and communities located in their states or districts. While we believe that the legislation is well-intended to expand access for more seniors to choose assisted living, we believe that critical changes are needed to preserve state flexibility, strengthen Medicaid waiver programs, and address reimbursement adequacy so providers can serve more seniors in high-quality, home-like settings.
Take Action: Share Your Concerns with the ACCESS Act
Background: The legislation is led by U.S. Senator Roger Marshall (R-KS) and U.S. Representative Max Miller (R-OH). Specifically, the legislation would:
- Make assisted living a mandatory Medicaid benefit. The bill amends Section 1902 of the Social Security Act to require state Medicaid programs to cover assisted living services in the same way nursing facility services are currently mandatory.
- Add assisted living to Medicaid’s definition of “medical assistance.” States would be required to cover services provided in licensed assisted living residences, consistent with state law.
- Apply only to individuals who meet nursing facility–level care criteria. Eligibility is limited to seniors who would otherwise qualify for hospital or nursing facility care under Medicaid rules.
- Require cost neutrality. Medicaid spending for individuals receiving assisted living services cannot exceed what Medicaid would have spent if those individuals received care in a hospital or nursing facility. The bill explicitly does not create a new eligibility population.
- Align Medicaid policy with housing development incentives. The legislation references coordination with housing policy, including use of the Low‑Income Housing Tax Credit, to support development of additional assisted living supply.